Provider Demographics
NPI:1699709261
Name:MR OF PARKVIEW LLC
Entity type:Organization
Organization Name:MR OF PARKVIEW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FISCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-488-6789
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6201
Mailing Address - Country:US
Mailing Address - Phone:201-488-6789
Mailing Address - Fax:201-488-7734
Practice Address - Street 1:201 5TH AVE
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-1059
Practice Address - Country:US
Practice Address - Phone:856-299-6800
Practice Address - Fax:856-299-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4498208Medicaid
NJ4498208Medicaid